Schizophrenia - diagnosis

Question 1

how to test for reliability in diagnosis

Answer 1

test-retest: same clinician assesses patient at different times
inter-rater: two clinicians assess patient at same time

Question 1

issues in reliability of diagnoses of schizophrenia

Answer 1

inconsistent due to differing standards. african-caribbean people 3-5x more likely to be diagnosed due to cultural differences

Question 2

how is schizophrenia classified in the UK and internationally

Answer 2

ICD-10, two negative symptoms must be present. subtypes were recognised but have recently been dropped

Question 3

how is schizophrenia classified in the US

Answer 3

DSM-5, one positive symptom must be present

Question 4

issues in diagnosis

Answer 4

• more likely to be diagnosed as schizophrenic under ICD-10
• co-morbidity around 50% for depression and substance abuse
• gender bias in diagnosis or genetics??
• african-caribbean more likely to be diagnosed
• symptoms overlap with different disorders
• inter-rater reliability low on ICD and DSM

Question 5

research showing issues in diagnosis

Answer 5

• Beck (1962) -> 54% inter-rater concordance rate across 150 pts
• Read (2004) -> concordance rate using different tools (37%)

Question 6

Rosenhan (1973)

Answer 6

being sane in insane places

Question 7

method of Rosenhan

Answer 7

7 volunteers faked a symptom of schizophrenia (hearing voice) and made themselves look disheveled, got admitted into psychiatric hospital. stopped faking symptoms and asked to leave

Question 8

findings of Rosenhan

Answer 8

most ended up being in hospital for around 1 month, longest 2 months. released in remission. challenged diagnostic symptom

Question 9

Rosenhan’s debrief and how it amplified findings

Answer 9

after experiment ended, debriefed hospitals. might send more pseudo-patients but never did. in months after, over 100 pts identified as pseudo even when real. unreliable and invalid diagnoses